Healthcare Provider Details

I. General information

NPI: 1225740475
Provider Name (Legal Business Name): TARA CARTER RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 NEWARK ST STE 404C
HOBOKEN NJ
07030-4543
US

IV. Provider business mailing address

629 38TH ST UNIT 1
UNION CITY NJ
07087-2518
US

V. Phone/Fax

Practice location:
  • Phone: 417-569-0656
  • Fax:
Mailing address:
  • Phone: 417-569-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number720544
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: